Rosh Hashana Dinner | www.jewishcanton.com

Dinner Registration

First Name *

Last Name *

Street Address

City

Postal Code

Email *

This event costs $36/ adult $10/ child

number of adults attending *

$36.00

number of children attending

$10.00

Total

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *